Provider Demographics
NPI:1023193273
Name:STOFKA, SHERILYNN (DDS)
Entity Type:Individual
Prefix:MS
First Name:SHERILYNN
Middle Name:
Last Name:STOFKA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3249
Mailing Address - Country:US
Mailing Address - Phone:802-775-9700
Mailing Address - Fax:802-775-3237
Practice Address - Street 1:66 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3249
Practice Address - Country:US
Practice Address - Phone:802-775-9700
Practice Address - Fax:802-775-3237
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00020761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery